{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T18:00:01Z","timestamp":1758477601224,"version":"3.44.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Rituximab (RTX) has gradually been accepted as a treatment for frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS) in children, but no standardized recommendations for the dosage and combination therapy exist. Additionally, the efficacy and safety of low-dose RTX in FRNS\/SDNS remain unclear, although it has been used to treat some autoimmune diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report a case series of 24 children diagnosed with FRNS\/SDNS treated with low-dose RTX followed by mycophenolate mofetil (MMF) for maintenance of remission of nephrotic syndrome between August 2021 and February 2023. These patients were followed up for at least 12\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean total dose for the initial four administrations of low-dose RTX was 470.83 \u00b1 62.41\u00a0mg, which was significantly lower than the calculated values for one standard dose (525.62 \u00b1 125.62\u00a0mg; <jats:italic>P<\/jats:italic> = 0.006) and two standard doses (1051.2 \u00b1 251.23\u00a0mg; <jats:italic>P<\/jats:italic> &amp;lt; 0.001). After treatment initiation, the median follow-up was 24.6 (16.8, 28.5)\u00a0months. At the 1-year follow-up, no child had experienced treatment failure, and the relapse-free rate was 83.3%. At the last follow-up, two children had experienced treatment failure, with both having frequent relapses, and the relapse-free rate was 75%. Compared with the calculated standard dose of RTX, low-dose RTX followed by MMF was less costly. No serious adverse reactions were observed during RTX use or follow-up, except for one death due to delayed treatment of severe infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low-dose RTX followed by MMF can extend the remission duration of FRNS\/SDNS in children, and decrease the economic burden on families, while offering good safety.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2025.1646837","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T05:28:41Z","timestamp":1756186121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Low-dose rituximab followed by mycophenolate mofetil for steroid-dependent\/frequently relapsing nephrotic syndrome in children: a case series"],"prefix":"10.3389","volume":"16","author":[{"given":"Jide","family":"Song","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunrong","family":"Shan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranran","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana","family":"Nie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cui","family":"Bai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuye","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dahai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1001\/jamapediatrics.2018.1323","article-title":"Efficacy of rituximab vs tacrolimus in pediatric corticosteroid-dependent nephrotic syndrome: a randomized clinical trial","volume":"172","author":"Basu","year":"2018","journal-title":"JAMA Pediatr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"884","DOI":"10.24953\/turkjped.2020.05.025","article-title":"Rituximab-induced serum sickness and anaphylaxis in a child with nephrotic syndrome","volume":"62","author":"Bayram","year":"2020","journal-title":"Turk J. 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